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POWERPOINT PRESENTATION ENGLISH 302 Shortened hospital stays may lead to additional problems. For example, the patient's mental health condition may not be fully stabilized by the time he or she is released. In addition, there may not be sufficient time to involve the patient's family or other caregivers in the treatment or to help them learn ways to manage the patient's behavior, such as how best to encourage him to attend outpatient treatment and to ensure adherence to medication instructions. If persons who need inpatient treatment or assisted outpatient treatment do not receive it, their exacerbations of illness will increase and they probably will present more frequently for emergency treatment. Moreover, with the shortage of psychiatric hospital beds, the treatment options for emergency psychiatrists are much more limited. THE SHIFT OF TREATMENT TO JAILS Statistics from the National Commission on Correctional Health Care indicate that 10% to 19% of persons in jails nationwide have a major mental illness, such as a schizophrenic or schizoaffective disorder, bipolar disorder, or major depressive disorder.4 Many of these persons have acute mental disorders and need emergency assessment. However, they do not receive treatment in psychiatric EDs but instead receive it in jail.1 How does this come about? CONCLUSION: Not meeting the needs of persons with severe mental illness for 24-hour structured care and involuntary community outpatient treatment has had a significant impact on emergency psychiatry. These persons more frequently present to EDs in psychiatric crises. Because persons with severe mental illness more often enter the criminal justice system, much emergency psychiatric evaluation and treatment takes place in jails. -------------------------------------------------------------- it is estimated that about 70,000 inmates in U.S. prisons are psychotic. Anywhere from 200,000 to 300,000 male and female prison inmates suffer from mental disorders such as schizophrenia, bipolar disorder and major depression. Prisons hold three times more people with mental illness than do psychiatric hospitals, and U.S. prisoners have rates of mental illness that are up to four times greater than rates for the general population. "Ill Equipped: U.S. Prisons and Offenders with Mental Illness" resulted from two years of research and hundreds of interviews with mental health care experts, prisoners, correction officials and attorneys. It reported that few prisons offer adequate mental health care services and that the prison environment is dangerous and debilitating for prisoners who have mental illness. These prisoners are victimized by other inmates, punished by prison staff for behaviors associated with their illnesses and often placed in highly restrictive cells that exacerbate their symptoms. The majority of people with mental illness in the criminal justice system are there for misdemeanors and crimes of survival, according to Osher. He said, "There's a whole host of folks who land in the criminal justice system because of their behavioral disorders." The problem primarily affects people on the margins of society. They are often minorities, almost always impoverished and disabled by their illness. The federal government's war on drugs has swept up people with mental illness at higher rates than those for the general population because more people with mental illness use and abuse drugs, Osher said. He added, "I think we want to watch the policy around punishment versus treatment, and we want to be advocates for treatment first." There is also a high prevalence of people coming into the mental health care system with a history of involvement with criminal justice. Mental health care professionals need to be aware of this and think about the necessary communications with law enforcement and correctional supervision officials. "I think the issue is that many folks in mental health care don't want to work with people who have a criminal justice history, but they do anyway," Osher said. "They're just not looking for it." Inmates with mental illness are often punished for their symptoms. Being disruptive, refusing to obey orders, and engaging in acts of self-mutilation and attempted suicide can all result in punitive action. As a result, the report noted, prisoners with mental illness often have extensive disciplinary histories. Frequently, the prisoners end up in isolation units Mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls. ... Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain. Example: A mentally ill man committed suicide in a county jail after he was arrested for threatening to kill himself. The Prisoners? Rights Program won a substantial monetary settlement for his surviving family and required the jail?s policies and training undergo a review by an independent expert; A seriously mentally ill immigrant from Iran was arrested following a misunderstanding at a convenience store. During the months he spent in jail, he was denied treatment for his mental illness, and ultimately assaulted by two jail guards who punched him in the face and shaved off the beard he was growing for religious reasons. The Prisoners? Rights Program won an $80,000 settlement; Online chart picture DESCRIPTION Quite a few news sources are covering the recent Human Rights Watch report on the incarceration of the mentally ill. Key data in the report: As many as one in every five of the 2.1 million people in American prisons suffer from one of three acute mental illnesses: schizophrenia, bipolar disorder, or severe depression. Since the 1960s, the population of US mental hospitals has dropped from almost six hundred thousand to eighty thousand; there has been an offsetting increase in the number of severely mentally ill Americans in prisons and on the streets. Close to three quarters of a million mentally ill Americans are admitted each year to prisons or jails. In prison, the mentally ill receive little or no treatment, and a disproportionate amount of punishment and solitary confinement. Mandatory and 'three-strikes' sentencing legislation catches a lopsided proportion of the mentally ill. Put this data together with data on the number of mentally ill on the streets, and you get the sorry picture shown in the above chart. It's a picture of neglect, heartlessness and false economy. Human Rights Watch calls for more money for treatment and therapy of mentally ill prisoners. With the skyrocketing cost of the epidemic of incarceration (quadruple the number of thirty years ago), and a right-wing Attorney-General with an extraordinary taste for blood, don't hold your breath.Whatever happened to the concept of 'not guilty by reason of mental defect'? "Let us say Good Bye to our loved ones. Once a prisoner becomes ill and goes to the hospital, all visits end. Hundreds of prisoners have died while there their families are denied final visits to them. This type of pain is something that the family unit will never be able to forget and it happens daily at prisons throughout California. Once a prisoner becomes too sick to make it to the visiting room, that is the end of their relationship with their families. If they become too sick to fill out forms, their parents and brothers and sisters will never be able to see them again. Family ties are vital to the health of mentally ill prisoners who have no business being sent to prison in the first place Long periods of being locked up with little mental stimulation is bad for the mental health of prisoners. Nurse and colleagues (p 480) conducted focus groups with prisoners and prison staff in a medium security remand prison in southern England and found that long hours of social isolation contributed to feelings of anger, frustration, and anxiety. Prisoners attributed drug misuse to social isolation. Prison staff said that fewer staff, more prisoners, high staff sickness rates, and prison staff management styles increased their stress levels. The authors state that health professionals, primary care trusts, policy makers, and prison management need to address prison environmental factors and the mental health of prison staff to have an impact on the mental health of prisoners.? ----------------------------------------------------------------------------- Cunningham story: BOSTON, March 8 ? Placed in solitary confinement in a Massachusetts prison, Mark Cunningham tried to kill himself last year, advocates for inmates say. Mr. Cunningham cut his legs and arms. He tried to hang himself with a tube from a breathing machine he used for sleep apnea. He smashed the machine to get a sharp fragment to slice his neck and ate pieces of it, hoping to cause internal bleeding. Five weeks ago, after being placed in solitary confinement again, Mr. Cunningham, 37, hanged himself. Mr. Cunningham?s case is one of 18 suicides and suicide attempts by inmates in solitary confinement ?We aren?t saying these folks should go free; we aren?t saying they shouldn?t be under high security conditions,? said Stanley J. Eichner, executive director of the Disability Law Center. But Mr. Eichner said putting prisoners in solitary conditions and denying them adequate mental health services was ?literally the fatal flaw in the system.? --------------------------------------------------------------------------------------------------------------------------------------- A seriously mentally ill immigrant from Iran was arrested following a misunderstanding at a convenience store. During the months he spent in jail, he was denied treatment for his mental illness, and ultimately assaulted by two jail guards who punched him in the face and shaved off the beard he was growing for religious reasons. The Prisoners? Rights Program won an $80,000 settlement; MOVIE CLIP: http://www.cbsnews.com/video/watch/?id=2458916n&tag=related;photovideo You wouldn't imagine these days that a mental patient could be chained to a concrete slab by prison guards until he died of thirst, but that?s how Timothy Souders died and he is not alone. Souders suffered from manic depression. And like a lot of mental patients in this country, he got into trouble and ended up not in a hospital, but in jail. It was a shoplifting case and he paid with his life. Conclusion: The potential result of relying on prisons - whose primary purpose in our country is to punish, not rehabilitate - to handle mentally ill inmates is ignominiously illustrated by Tim Souders' case: leaving inmates to die of dehydration while chained to a slab; treatment not fit for an animal, let alone a human being.

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